Effect of HIV-infection on QuantiFERON-plus accuracy in patients with active tuberculosis and latent infection

• DOI: 10.1016/j.jinf.2020.02.009
• Publication Date: 2020-02-22T07:26:19Z
• Authors: Elisa Petruccioli; Teresa Chiacchio; Assunta Navarra; Valentina Vanini; Gilda Cuzzi; Claudia Cimaglia; Luigi Ruffo Codecasa; Carmela Pinnetti; Niccolò Riccardi; Fabrizio Palmieri; Andrea Antinori; Delia Goletti
• Keywords: 0301 basic medicine; 03 medical and health sciences; Latent Tuberculosis; Tuberculin Test; Latent Infection; Humans; Tuberculosis; HIV Infections; Mycobacterium tuberculosis; Interferon-gamma Release Tests; 3. Good health

HIV-infection increases the risk to progress to active-tuberculosis (TB). Detection of latent TB infection (LTBI) is needed to eventually propose preventive-therapy and reduce TB reservoir. QuantiFERON-TB Plus (QFT-Plus)-test identifies LTBI. Currently, only two studies on QFT-Plus accuracy in HIV-infected-population are available in high TB-endemic-countries. Therefore we aimed to evaluate the effect of HIV-infection on QFT-Plus accuracy to detect LTBI in a low TB-endemic-country.We enrolled 465 participants, among the 167 HIV-infected-persons: 32 with active-TB (HIV-TB), 45 remote-LTBI (HIV-LTBI) and 90 at low M. tuberculosis (Mtb)-infection risk. Among the 298 HIV-uninfected-persons: 170 with active-TB, 76 recent-LTBI, 34 remote-LTBI and 18 with low Mtb-infection risk.QFT-Plus sensitivity was similar in TB regardless of HIV-status. CD4-count did not influence the distribution of IFN-γ values in HIV-TB and HIV-LTBI. Moreover HIV-LTBI and HIV-uninfected remote LTBI had a similar proportion of results in the uncertain range (IFNγ ≥0.2 ≤ 0.7 IU/ml) differently from those LTBI-persons reporting recent-exposure (p = 0.016). Cytometry results demonstrated that CD8-response was similar in HIV-infected- and -uninfected-persons whereas CD4-response was impaired in HIV-infected-persons (p = 0.011).HIV-infection does not affect QFT-Plus response in active-TB, whereas the time of exposure influences the proportion of uncertain-results in LTBI.